Table : Survival Benefits Of Early Treatment
An analysis of 98 men with prostate cancer that had spread to the lymph nodes, who were randomly assigned to receive immediate hormone therapy or to forgo it until the disease spread further to bones or lungs, found that early treatment saved lives.
Deaths from prostate cancer 21 Source: Lancet Oncology 2006 7:4729. PMID: 16750497.
Other studies have shown that starting hormone therapy early on increases survival times, delays cancer progression, and results in better quality of life. However, in a review of four studies involving 2,167 men with metastatic prostate cancer, the Cochrane Collaboration concluded that early hormone therapy had offered only a small overall survival advantage over deferred treatment, and cautioned that more research on the issue needs to be done.
Although debate on this issue continues, in most cases I advise my patients with metastatic disease to begin hormone treatment early on. This is particularly important for someone with spine metastases, because a bone fracture or extension of the cancer into the spinal cord area could lead to impaired mobility and even paralysis. Fortunately, this is a rare event.
Hormone Therapy Helps Some Prostate Cancer Survivors Live Longer
A study published in the New England Journal of Medicine in January 2017 indicates that men whose prostates are removed to treat prostate cancer are likely to survive longer if they take drugs to block the male hormone testosterone in addition to undergoing radiation therapy.
Unfortunately, its not that simple.
Histopathologic Changes In Nadt
Androgen deprivation therapy produces distinct histopathologic changes in neoplastic and nonneoplastic prostate tissue. A pathologist who is not familiar with these alterations may misinterpret the specimen, resulting in inappropriate tumor grading or missed tumor foci. Thus, the urologist should convey to the pathologist any information regarding therapy that might cause histopathologic changes.
Civantos et al published the largest series on the pathology of androgen deprivation therapy for prostate cancer, and in the series of 173 patients who were treated with a luteinizing hormone-releasing hormone analogue and an antiandrogen prior to radical prostatectomy , atrophy was observed in benign and malignant tissue. Examination of noncancerous tissue revealed atrophy of secretory cells, with cytoplasmic clearing and vacuolization. Atrophy and disappearance of luminal cells resulted in basal cell prominence. Morphologic alterations induced by treatment were patchy the entire neoplastic tissue was affected in only 57% of the specimens. The poorly differentiated areas of tumors were affected less frequently.
Three types of changes in neoplastic tissue were reported in the Civantos study :
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Confirming What Weve Practiced For Years
- What was the grade of the cancer?
- Was it at the edge of the removed prostate gland?
- Was it in the attached seminal vesicles or extending beyond the capsule?
- Was there cancer in any removed lymph nodes?
- What is the trend of serum PSA since surgery?
- How old is the patient, what are his other medical issues, and what are his goals?
Prostate Cancer Information: Prostate Cancer Hormone Therapy
Prostate cancer hormone therapy is the systemic ablation of the bodys testosterone which, for a period of time, will slow or stop the growth and spread of prostate cancer. Hormone therapy may also be called androgen deprivation or androgen ablation.
The Role of Hormones in Prostate Cancer The male sex hormone, testosterone, causes the growth of the prostate gland and other sex organs in the developing male. Even as men pass through the age of puberty, testosterone continues to contribute to the growth of the organ. Testosterone will fuel the growth of any prostatic cell: the chemical cannot discriminate between the receptors of healthy tissue and cancerous tissue. Prostate cancer hormone therapy removes the chemical that feeds cells and can stop or slow the growth and spread of the tumor.
Where does Testosterone Come From? A chemical sequence in the brain signals the testicles, which make 90% of the bodys hormones, to begin production. A structure in the brain called the hypothalamus continually monitors the blood stream for adequate levels of testosterone. If these levels drop, the hypothalamus releases a chemical called GnRH or LHRH . GnRH acts as a messenger and travels to the pituitary gland where it plugs into designated receptors.
How is Hormone Therapy Administered? There are four basic methods androgen deprivation: castration, estrogen, anti androgens, and combine androgen blockade.
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How Effective Is It
Hormone therapies, such as Lupron, are often effective in combination with other treatments for people with late-stage prostate cancer. Many doctors do not recommend hormone therapy during the early stages of this disease.
One potential issue is that prostate cancer can become resistant to LHRH agonists over time in some people.
According to the ACS, doctors may recommend hormone therapies, such as Lupron, for:
How Much Hormone Therapy Costs
The cost of hormone therapy depends on:
- the types of hormone therapy you receive
- how long and how often you receive hormone therapy
- the part of the country where you live
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.
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Hormonal Therapy On Its Own For Early And Locally Advanced Prostate Cancer
If your doctors are using the watchful waiting approach and the cancer starts to grow, you may have hormonal therapy on its own.
Some people with early prostate cancer decide to have hormonal therapy on its own instead of with surgery or radiotherapy. Some people with locally advanced cancer decide to have hormonal therapy on its own instead of radiotherapy. Unlike these treatments, hormonal therapy on its own will not get rid of all the cancer cells. Doctors do not usually advise this. But it may be suitable if you:
- are not well enough to have surgery or radiotherapy
- do not want these treatments.
Hormonal therapy can slow down or stop the cancer cells growing for many years. Not having surgery or radiotherapy means you avoid the side effects of these treatments. Hormonal therapy can also cause side effects . It is important to talk to your doctor or nurse about it before you decide.
Types Of Hormone Therapy
The table at the right provides an overview of three commonly used types of hormone therapy. These and others are discussed below. While hormone therapy is commonly used, side effects of the treatment are reported as well. They range from erectile dysfunction, hot flashes, weight gain and loss of bone density.
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What Kinds Of Medical Information Should I Keep
It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.
- The results of any tests you have taken such as your Prostate-Specific Antigen test.
- When you found out you had prostate cancer.
- Information on the kinds of treatment you have had for your prostate cancer including:
- The places and dates where you had your treatment.
- What type of treatment you had. And,
- Any medicines you took before, during, and after your prostate cancer treatment.
Hormone Therapy Can Cause Side Effects
Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.
Some common side effects for men who receive hormone therapy for prostate cancer include:
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How Is Hormone Therapy Given
Hormone therapy is most often used to treat breast and prostate cancers, where its role is well established through numerous clinical trials. Meanwhile, research is ongoing to study the potential use of hormonal therapy in treating other cancer types. Hormone therapy can be given in a few ways:
- Oral medication some therapies are taken by mouth.
- Injection some therapies are given by an injection under the skin or in the muscle .
- Surgical intervention for example, removal of the ovaries in women, or testicles in men, results in decreased production of certain hormones.
Many patients think of hormone therapy as being “less potent” than chemotherapy, but it can be just as effective in certain breast and prostate cancers. Hormone therapy is considered a “systemic” therapy, meaning that it travels throughout the body. Surgery and radiation therapy are considered “local” treatments.
Intermittent Therapy For Locally Advanced And Advanced Prostate Cancer
Instead of taking the drugs continuously, you may stop taking the drugs for a while and then start taking them again. This is called intermittent hormonal therapy. It means you get a break from the side effects of hormonal therapy. This is not suitable for everyone. It should only be done following your doctors advice.
Intermittent hormonal therapy may be helpful when certain side effects are difficult to cope with. Your doctor or nurse will explain the possible advantages and disadvantages. If your PSA level begins to rise or your symptoms get worse, your doctor will advise starting hormonal therapy again.
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What Types Of Hormone Therapy Are There
There are three main ways to have hormone therapy for prostate cancer. These are:
- injections or implants
- tablets
- surgery to remove the testicles .
The type of hormone therapy you have will depend on whether your cancer has spread, any other treatments youre having, and your own personal choice. You may have more than one type of hormone therapy at the same time.
Injections or implants
These stop your body from making testosterone. They work by blocking the message from the brain that tells your testicles to make testosterone.
Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.
Ask your doctor or nurse whether you will have injections or implants. They are both given using a needle.
Injections use a needle to inject a small amount of liquid under the skin or into muscle. They may be given in your arm, abdomen , thigh or bottom , depending on the type youre having.
Implants may be given as a small pellet that is placed under the skin in the abdomen and slowly releases the drug.
You will have the injections or implants at your GP surgery or local hospital. How often you have them will vary, depending on the type you are having.
Some men have an injection or implant once a month, while others have an injection every three or six months.
LHRH agonists
LHRH agonists are the most common type of injection or implant. There are several available that all work in the same way, including:
GnRH antagonists
Tablets
Abiraterone acetate
How Are Treatments Administered
GnRH agonists are either injected or placed as small implants under the skin. Anti-androgens are taken as a pill once per day. Degarelix is given as an injection. A chemotherapy drug called docetaxel is sometimes used in combination with these hormone therapies.
Zytiga is taken by mouth once per day in combination with a steroid called prednisone.
Surgery to remove the testicles can be done as an outpatient procedure. You should be able to go home a few hours after an orchiectomy.
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Hormonal Therapy For Endometrial Cancer
Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:
- Tamoxifen
- LHRH agonists
- Aromatase inhibitors
When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.
Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.
Expert
What Are Hormones And How Are They Used As Therapy
Hormones are chemicals that are naturally produced by the organs that make up the body’s endocrine system . These chemicals travel throughout the body through the bloodstream, helping carry out the different jobs of various organs in the body. Hormones regulate just about every cell in the body. Some examples of hormones include: estrogen, testosterone, insulin, thyroid hormone, cortisol, and epinephrine.
Researchers have found that some cancers are “fueled” by hormones, and may depend on them to grow. In these cases, blocking the action of these hormones could possibly stop the cancer from growing. There are a few ways in which this can happen:
Hormone therapy that is used to treat certain cancers should not be confused with hormone replacement therapy. Hormone therapy is used to block hormones or their actions, whereas hormone replacement therapy, which is not a cancer treatment, usually refers to giving hormones to replace the ones the body no longer makes in order to treat menopause-related symptoms.
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What Side Effects May I Have After I Start Hormone Therapy
The side effects that you may have after you start hormone therapy include: erectile dysfunction or impotence , lower sexual desire , hot flashes, fatigue , weight gain, breast enlargement, osteoporosis, anemia, memory loss, and cardiovascular problems. The following side effects can happen as soon as you start your treatment.
Erection problems
Difficulty getting or keeping an erection is a common side effect of hormone therapy for prostate cancer. This is also called impotence. Hormone therapy lowers the amount of testosterone in your body or stops your body from making testosterone.
Lower sex drive
Hot flashes and sweating
Breast tenderness or growth
Some men may find that their chest becomes sore and that their breasts get a little bit swollen. This is called gynecomastia . There are medicines and treatments that you doctor or health care team can give you to help with this side effect.
Fatigue
The drop in your testosterone level may make you feel very tired. You may feel tired all the time or you may get tired more easily when you do your daily activities. This is known as fatigue or tiredness. There are things you can do to help deal with this treatment side effect.
Tumor flare pain
The following side effects may happen if you take hormone treatment for a long period of time. These are:
Weight gain
Memory problems
Anemia
Bone thinning
There are several ways you can help to lower your osteoporosis risk
Cardiovascular problems
What Kinds Of Medicines Can Be Used To Lower My Testosterone
There are several types of medicines you can take to lower the amount of testosterone in your body. These are temporary ways to lower the amount of testosterone. When you stop taking these medicines, your testosterone level will begin to go up.
LHRH agonist
LHRH is a normal human hormone that tells your body to make testosterone. An LHRH agonist is a man-made hormone similar to the one made naturally in your body. LHRH agonists work like a light switch to shut off the production of testosterone in your body. When you are given this medicine, your body will stop making the LHRH hormone and your testicles will stop making testosterone. When you are first given this medicine, your body will continue to make testosterone for a couple of weeks. This means that your testosterone level may go up for a week or two and then begin to drop. This type of medicine works as well as having an orchiectomy . These medicines are given either monthly or every three months in a shot . The medicine may also be placed as small implants under your skin. The implant gives you a steady dose of medicine. Depending on the type of implant the medicine may last from one to 12 months.
Anti-androgens
Anti-androgens act like a brick wall. They block the small amount of testosterone made in your adrenal glands from reaching your prostate cancer cells. This keeps your prostate cancer cells from growing. These medicines are pills that are taken orally one to three times a day.
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